HomeMy WebLinkAboutDrain Layers Permit Grandview Terrace II R
TO --OF SOUTH WINDSOR
c�
DEPARTMF _Q PUBLIC WORKS
=ZIMEAV—Dr POLLUTION CONTROL
...DRAIN LAYER'S PERMITS __6 2 7 7
Pursuant to written :'- `�`'ii�a1tion pp , permission is h-ereby granted to the
Licensed Drain Layer named lyerein to perform the work indicated-below at
�'( at premises owned by �, � 1''t rii
whose address 'isC74x4 and to
Lay House Drain, Repair douse Drain, Lay Main, Other
for occupancy or use, wit
Family Units , with acres .
Type of Sewage to be . connected under this permit : SANITARY SEWAGE ) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings .
emu$ I 65la 14 puS0- ( 1iVl
OSHA REQUIREMENTS MU T BE FO L ED
SPECIAL CO DI7N�S _ cti^
2 A I,
Desire Starting Date Estimated ompletion I tLio/dT
Permit to be issued to
the holder o?� ^a <La is License No. p-y�y Permit will expire thirty
( 30) days of er d e o issuance. The undersigned Drain Layer h r b' I ee�
to all the t m . a ondit oms set forth n the permit and theiwf
thereof . �A p s re it No an or�,�`
ed rm
CHD Permit No .
Signed '
icense rain Layer
The above named Drain Layer has a id license issued by the State of
Connecticut and`. has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor :
�{. 'Engineering Dept . Date
Permit Fee Paid $
A
Check Number
Connection Charge Receipt No. Dated
INSPECTION
Date work started `? S D a t e_c_V, 4� �7WZXW
Sufficient notificaf'ion re eivea :— 'yes No
Special Co ditions
A P P ioVED• 7
- Inspector Date
I uylLmn0'%&- (X YMIIW11 rVnIVII1
INSPECTION REQUEST
DATE OF •REQU..EST — i TIME: t� 0
Of
BY: FOR LOCATION:
t.: DAY2SPECS NEEDED �-- '� TIME: r Q
TYPE OF INSPECTION: c
(. ` SANITARY/LATERAL (TERMIT. NO 6- Z17 FOOTING:,DRAIN—
EXCAVATION
( �. ) EXCAVATION (PERM= .NO. ) ( ) OTHER
4
INSPECTlON-.,RE -,ORT
]DATE: —�4 TIME: r0 ilk/ INSP
� F
s ` CONTRALTO, . . `_3 �� � � WEATHER-.
614
�� o�
WORK.-IN PROGRESS:: Qom► Cs��/2 � � �✓/cz�� � ���
ci
' e
A�
AREA OF CONCERN:
?' SPECIAL INSTRUCTIONS: